"By and large, women with substance use disorders must find a way to support themselves and their children, often with little experience or education and few job skills. They frequently have to overcome feelings of guilt and shame for how they treated their children while abusing substances. When a woman becomes pregnant, her motivation to seek treatment may rise greatly. However, pregnancy itself can be a barrier to treatment because substance abuse treatment programs are not always able to admit pregnant women or to provide the services required, such as medically indicated bed rest, transportation to prenatal care, and nutritious meals (Jessup et al. 2003). Some women fear the negative consequences that will result if their substance abuse becomes known. In many States, pregnant and parenting women can be reported to child protective services, lose custody of their children, or be prosecuted for using drugs. On top of additional healthcare needs, substance use during pregnancy confers stigma and shame, which may create another challenge in treatment.

"A high proportion of women with substance use disorders have histories of trauma, often perpetrated by persons they both knew and trusted. A woman might have experienced sexual or physical abuse or witnessed violence as a child. She may be experiencing domestic violence such as battering by a partner or rape as an adult (Finkelstein 1994; Young and Gardner 1997). These traumas contribute to the treatment needs for women.

"The societal stigma toward women who abuse substances tends to be greater than that toward men, and this stigma can prevent women from seeking or admitting they need help. Women who use alcohol and illicit drugs often have great feelings of shame and guilt, have low levels of self-esteem and self-efficacy, and often are devalued or disliked by other women. These feelings make it difficult for women to seek help or feel that they deserve to be helped— creating yet more treatment needs that must be addressed. Gender role expectations in many cultures result in further stigmatization of substance use; additional challenges face women who are of color, disabled, lesbians, older, and poor."


Substance Abuse and Mental Health Services Administration. Substance Abuse Treatment: Addressing the Specific Needs of Women. Treatment Improvement Protocol (TIP) Series, No. 51. HHS Publication No. (SMA) 13-4426. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2009.